Diabetes Mellitus among Persons with Tuberculosis in the United States, 2009-2011 Open Access

Abstract

Background: Both tuberculosis (TB) and diabetes mellitus (DM) remain major public health problems, and their association has been the topic of much research. Several studies have provided evidence that DM increases the risk of TB; however the risk factors involved in this relationship are less well-known.

Objectives: The purpose of this study was to analyze important risk factors in the relationship of TB and DM using United States' TB surveillance data.

Methods: Data collected from 2009-2011 as part of the National Tuberculosis Surveillance System (NTSS) was used to compare cases of TB with and without DM. Logistic regression was used to model characteristics of TB cases with and without DM in univariate and multivariate analyses.

Results: From 2009 to 2011, there were 28,611 cases of reported TB in the United States, 13.8% (n=3,951) of which also had reported DM. As age at TB diagnosis increased, the odds of having TB-DM vs. no DM increased in a dose-response pattern, with cases aged 65 and over having an odds of TB-DM 98.3 times greater than the 5-14 year old age group (95% CI 24.4, 225.8). Native Hawaiian/Pacific Islanders (OR: 5.5, 95% CI 3.7, 8.2) and Hispanics (OR: 3.2, 95% CI 2.9, 3.7) were the racial/ethnic groups with the highest odds of having DM compared to non-Hispanic whites. TB cases with end-stage renal disease (ESRD) had 3.5 higher odds of also having DM compared to TB cases without ESRD (95% CI 3.0, 4.2).

Conclusion: Several risk factors, including higher age, non-white race/ethnicity, and comorbid ESRD were positively associated with TB-DM. TB program workers should be aware of certain risk factors on the TM-DM relationship to tailor care, screening, and treatment for TB-DM cases.

Table of Contents

CHAPTER I: LITERATURE REVIEW…………………………………………………1

1. Tuberculosis……………………………………………………………...……1

a. Worldwide burden

b. Tuberculosis in the U.S

c. Drug resistance

d. Risk factors

2. Diabetes Mellitus……………………………………………………………...5

a. Worldwide burden

b. Diabetes Mellitus in the U.S

c. Risk factors

d. Increased susceptibility to infection

3. Comorbid tuberculosis and diabetes…………………………………..………9

a. Demographic risk factors

b. Clinical characteristics

CHAPTER II: MANUSCRIPT………………………………………………………….15

1. Introduction…………………………………………………………..…………..15

2. Methods………………………………………………………………….……….16

3. Results…………………………………………………………………...……….19

4. Discussion………………………………………………………………………..21

5. References………………………………………………………………..………24

6. Tables…………………………………………………………………………….29

CHAPTER III: CONCLUSION…………………………………………………….…..45

APPENDIX A: IRB APPROVAL……………………………………………………...46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	diabetes mellitus comorbidity tuberculosis NTSS
Committee Chair / Thesis Advisor	Venkat Narayan, K.M., Emory University
Committee Members	Miramontes, Roque, CDC
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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